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Treatment-resistant major depressive disorder and assisted dying: response to comments
  1. Udo Schuklenk1,
  2. Suzanne van de Vathorst2,3
  1. 1Department of Philosophy, Queen's University, Kingston, Ontario, Canada
  2. 2Department of General Practice, Section Medical Ethics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Medical Ethics and Philosophy, Erasmus Medical Centre/Erasmus University Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Udo Schuklenk, Department of Philosophy, Queen's University, Watson Hall, Kingston, Ontario, Canada ON K7L 3N6; udo.schuklenk{at}

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The commentaries responding to our article on treatment-resistant depression and assisted dying focus on the following issues: epistemological questions about death, patient competence, the role of doctors, the moral basis of the right to an assisted death, safety and security of patients, and questions about various cases that occurred in the Netherlands. We will address in our response each of these concerns, beginning with the last issue first.

Review of cases

Dr den Hartogh mentions a case in the Netherlands where the Dutch review committee deemed ‘the doctor … not careful’.1 This case was published after we submitted our paper. The case was judged ‘not careful’ because no psychiatrist had been consulted to consider the competence of the patient, and to review whether the patient's situation was truly of a hopelessness nature. In this case, the doctor who performed the euthanasia and the consultant were general practitioners. This case does not undermine our argument. The review committee did not suggest that the patient was incompetent. In our paper, we are careful to consider only treatment-resistant competent patients.

Dr Cowley mentions the so-called Chabot case and the Brongersma case.2 In the Netherlands, the Brongersma case is not discussed under the label ‘depression’, but as a case of a patient who was ‘tired of life’.3 Eighty-six-year-old former politician Edward Brongersma did not suffer from a mental or other illness. It deserves a separate discussion and is outside the scope of our paper. The Chabot case was extraordinary because the patient had no wish to be cured from her depression because she felt depression to be an appropriate state to be in after the premature deaths of her two sons.4 This case also falls outside the scope of our paper.

Epistemological uncertainty about death

Drs Broome and de Cates begin their discussion with an epistemological argument …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • iWe thank Abe Schwab for recalling The Apology in this context, and for bringing it to our attention.

  • ii“Een patiënt met ernstige recidiverende psychosen of depressies kan in de tussenliggende goede perioden vaak wel in staat geacht worden om met volledig ziektebesef tot een weloverwogen besluit tot zelfdoding te komen.“ Paragraph 2.2.2., page 32 in A.J. Tholen, R. L.P. Berghmans, J. Huisman, J. Legemaate, W.A. Nolen, F. Polak, M.J.W.T. Scherders (NVvP-commissie Hulp bij zelfdoding). 2009. Richtlijn omgaan met het verzoek om hulp bij zelfdoding door patiënten met een psychiatrische stoornis. De Tijdstroom, Utrecht.

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